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The State of Health in New Mexico 2018

12. Health Equity and Health Disparities

Advancing Health Equity Benefits All New Mexicans

An overarching goal of Healthy People 2020 is to "achieve health equity, eliminate disparities, and improve the health of all groups." Health equity is defined as "the absence of unfair and avoidable or remediable differences in health interventions and outcomes among groups of people." Achieving health equity means that all people have the opportunity to reach their full health potential and it depends on understanding health disparities among different populations and the factors that create those disparities.

Health disparities are preventable differences in the quality and quantity of health care that negatively impact specific population groups. Some populations experience a greater burden of disease due to a variety of factors including education, income level, cultural and linguistic barriers, racism, historical trauma, and inadequate access to timely and appropriate healthcare.

There is strong evidence to support the significance of health disparities. Research also supports the conclusion that despite the development and implementation of interventions that address individual-level determinants, health disparities continue to be persistent and significant. Thus, advancing health equity requires looking beyond individual-level determinants to those social, economic, and policy factors that are beyond an individual's control, and focusing on the social determinants of health and on development of population-level solutions.

Health Disparities in New Mexico

Information on health disparities has been incorporated throughout this report, but selected health disparities in New Mexico warrant special attention.
Cardiovascular Disease
In 2016, the overall death rate in New Mexico for heart disease was 143.8 per 100,000 people. African American adults had the highest heart disease death rate. This rate was statistically significantly higher than the overall rate for the state and that of all other racial/ethnic groups. The heart disease death rate of White New Mexicans was statistically significantly higher than the rates of all other racial/ethnic groups except those who were African American.
Influenza & Pneumonia Deaths
American Indians in New Mexico experience the highest rate of pneumonia and influenza (P&I) deaths (Figure 2), approximately double the New Mexico and U.S. rates, and at 34.6 deaths per 100,000 persons, is higher than the combined rates of New Mexico's other racial and ethnic groups (14.6 per 100,000). According to the CDC, persons whose race is American Indian/Alaska Native are at a higher risk of complications from the flu and are more likely to be hospitalized from the flu than the general U.S. population. The reason for higher flu complications is not well understood; however, social and economic factors in American Indian populations may result in reduced access to healthcare and crowded living conditions (Figure 3) and thus a higher risk for flu complications.

The CDC recommends that all persons who are American Indian receive the annual influenza vaccination. Additionally, the CDC recommends antiviral treatment as soon as possible for any American Indian patient with confirmed or suspected influenza illness.

The NMDOH developed the Pneumonia and Influenza Death Rate Reduction Initiative Among Native Americans in New Mexico. This initiative aims to reduce P&I death rates by 1) enhancing understanding about the issue; 2) creating and strengthening collaborations among numerous stakeholders; and 3) ensuring the sustainability of key elements of this initiative among all stakeholders.
Diagnosed Diabetes in Adults
In 2016, diabetes prevalence was significantly higher among American Indian/Alaska Native adults than among Hispanic and White adults, and was significantly higher among Hispanic adults than among White adults. Diabetes was the 6th leading cause of death overall in New Mexico in 2016, but there were differences in rank order by race/ethnicity. Diabetes was the 4th leading cause among Asian/Pacific Islanders, 5th among Hispanics and American Indians, 7th among Black/African Americans, and 8th among Whites.

Disparities exist for overall health in both New Mexico and the U.S. More than 20% of the population has reported a health status of fair or poor, with greater disparities among Hispanics, Blacks or African Americans, and American Indians, and well over the national percentage of 16.7%. Specifically, individuals with less than a high school education, and those making less than $15,000 a year report fair or poor health status more often than any other group.

Contributing Factors, Risk and Resiliency

Health disparities occur across many dimensions, including: socioeconomic status, race/ethnicity, age, gender, sexual orientation, disability status, primary language, and location. New Mexico is a minority-majority state where greater than 60% of the population self-identifies as a racial or ethnic minority. According to 2016 U.S. Census Bureau estimates, 2,082,669 people lived in New Mexico. Of these, 48.5% self-identified as Hispanic, 37.8% self-identified as White and 10.1% self-identified as American Indian. Almost 25% of the population lives in a rural area (with the percentage of the state's population living in a Primary Care Health Professional Shortage Area estimated at over 40%), 15.1% had a disability, 34.5% of the state's population over the age of four speaks a language other than English at home, and nearly 20% of the population lives below the poverty level.. Additionally, approximately 3% of New Mexico adults identified as lesbian, gay, or bisexual. In other words, the majority of New Mexicans belong to at least one population group at high risk of experiencing health disparities. Accordingly, to improve health for New Mexico overall, public health must have in its core principles and values the advancement of health equity and the elimination of health disparities.

Assets and Resources

There are numerous efforts to address Health Equity. Foundations such as Con Alma, The McCune, Kellogg, Robert Wood Johnson, Notah Begay III, Santa Fe Community and others have grant funded programs with health equity as a goal. Many of the colleges and universities across the state have programs and efforts to address health equity, and the University of New Mexico's Health Science Center includes health equity in their vision. Organizations like the New Mexico Public Health Institute, Health Equity Partnership, Presbyterian Healthcare, New Mexico Community Health Worker Association, the YWCA New Mexico, and the New Mexico Public Health Association have mobilized around health equity. Further, there are other state agencies, county and city offices that focus on health equity. These are all assets and resources dedicated to health equity in New Mexico.

NMDOH Office of Health Equity (OHE) is committed to improving the health of all diverse communities in New Mexico and raising awareness of health disparities through collaboration, education and advocacy. The NMDOH Office of the Tribal Liaison works to strengthen tribal health and public health systems through on-going collaboration with American Indian tribes, pueblos, and nations, respecting the tenets of sovereignty and self-determination held by indigenous nations in the state. The NMDOH Office of Border Health (OBH) works to improve health status and health services in the U.S.-Mexico Border Region and other border-impact areas of New Mexico. The NMDOH Office of Community Health Workers (OCHW) has strong ties to New Mexico communities and is focused on increasing access to high-quality, cost-effective, and integrated health care and social services.

In addition to improving the health status of New Mexicans, increasing health equity has a positive impact on the economy by reducing unnecessary health care spending. At the national level, it is estimated that the elimination of health disparities among racial/ethnic minority groups would have saved nearly $230 billion in direct expenditures for medical care and more than $1 trillion in indirect costs associated with premature death and illness between the years of 2003 and 2006.

Summary

Three notable health disparities in New Mexico involve three high-ranking causes of death: deaths from heart disease, influenza and pneumonia, and diabetes. Health disparities exist along a variety of social dimensions in New Mexico, to the extent that the majority of New Mexicans may be affected. Advancing health equity is likely going to improve health for New Mexico overall, as well as provide economic benefits to the state. But we cannot rely on individual-level interventions to make gains in health equity. Instead, population-based approaches that reduce poverty, improve the health care safety-net, and address racial discrimination will be necessary to reap the health and economic benefits of health equity in New Mexico. References

Figure 1. Diagnosed Cardiovascular Disease* by Race/Ethnicity, New Mexico Adults Aged 18 Years and Older, 3-Year Moving Averages from 2006-2016 Cardiovascular Disease* in Adults Aged 18 and Older by Race/Ethnicity Age-adjusted to U.S. 2000 standard population
*Doctor-diagnosed Stroke, Heart Attack, or Coronary Heart Disease
Data from 2010 and earlier may not be comparable to later data.
2003-2010 A/PI rates were omitted because they were unstable.
Source: NM BRFSS, NMDOH
Figure 2. Deaths from Pneumonia and Influenza by Race/Ethnicity, New Mexico, 5-Year Moving Averages from 2003-2016 Deaths from Pneumonia and Influenza by Race/Ethnicity Age-adjusted to U.S. 2000 standard population
Source: NMDOH BVRHS
Figure 3. Percentage of Households with a Ratio of Occupants per Room Over 1.0 by Race/Ethnicity, New Mexico, 2016 Percentage of Households with a Ratio of Occupants per Room Over 1.0 Race defined as "race alone" - persons reporting two or more races were not included.
*Estimate for Asian, alone. Data were not available for Native Hawaiian/Other Pacific Islander.
Source: U.S. Census Bureau, ACS 1-year estimates

What is Being Done?

  • Improved language access through translated materials and interpretation.
  • Health Literacy training at New Mexico Public Health Association targeting community health workers and public health practitioners.
  • Addressing limited English proficiency by providing over 700 documents in languages other than English

What Needs to be Done?

  • Develop intersectoral and non-traditional partnerships in communities across the state
  • Develop health equity capacity.
  • Replace community deficit models with strengths-based or equity model that capitalizes on community resources and strengths.
  • Implement a branding strategy to build better health literacy, especially with documents geared to limited English profeciency populations.
The information provided above is from the New Mexico Department of Health's NM-IBIS web site (http://ibis.health.state.nm.us). The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Thu, 22 August 2019 from New Mexico Department of Health, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.nm.us".

Content updated: Tue, 20 Mar 2018 15:16:58 MDT